Peck Electric Incorporated
(Drug-Free Workplace-Pre-employment Drug Test Required)
Application For Employment
(Please Print)
Equal access to programs, services and employment is available to all persons. Applicants requiring reasonable accommodations to the application and/or interview process should notify the Human Resources Department.
Position(s) applied for______
Referral source □ Advertisement □ Government Employment Agency □ Private Employment Agency
□ Walk- in □ Employee □ Relative □Other______
Name______
Last First Middle Social Security #
Address______
Street City State Zip Code Telephone #
If you are under 18 and it’s required, can you furnish a work permit? □ Yes □ No
If no, please explain______
Have you submitted an application here before? □ Yes □ No If yes, give dates______
Have you ever been employed here before? □ Yes □ No
Are you legally eligible for employment in this country? □ Yes □ No
Are you able to meet the attendance requirements of the position? □ Yes □ No
Have you ever been bonded? □ Yes □ No
Have you ever plead □ guilty or □ no contest to, or been convicted of a crime? □ Yes □ No
If yes please provide the date(s) and details. ______
______
(Answering Yes to these questions doe not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.)
Drivers license number #______State______
EDUCATIONAL BACKGROUND - List high school, college or trade/ vocational school.
SCHOOL/CITY AND STATE / YEARS ATTENDED / DEGREE /DIPLOMA /MAJORSkills and qualifications (special training, skills, licenses and/or certificates that may qualify you as able to perform job-related functions in the position for which you are applying) ______
______
References: List 3 people who you are not related to and who you have known for at least 1 year
NAME / TELEPHONE / YEARS KNOWN
EMPLYOMENT HISTORY: Please explain any gaps in employment in comments section below.
Job Title______Date Employed From ______to______
Employer______Address______Telephone ____-_____-_____
Hourly Rate or Wage – Starting $ ______per ______Ending $______per______
Summarize the type of work performed and job responsibilities ______
______
Reason for leaving ______
May we contact reference? □ Yes □ No □ Later
Comments______
______
Job Title______Date Employed From ______to______
Employer______Address______Telephone ____-_____-_____
Hourly Rate or Wage – Starting $ ______per ______Ending $______per______
Summarize the type of work performed and job responsibilities ______
______
Reason for leaving ______
May we contact reference? □ Yes □ No □ Later
Comments______
______
Job Title______Date Employed From ______to______
Employer______Address______Telephone ____-_____-_____
Hourly Rate or Wage – Starting $ ______per ______Ending $______per______
Summarize the type of work performed and job responsibilities ______
______
Reason for leaving ______
May we contact reference? □ Yes □ No □ Later
Comments______
______
I give the employer the right to contact and obtain information from all references, employers, schools, and to verify the accuracy of the information contained in this application. I hereby release the employer and its representatives from liability for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.
This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still which to be considered for employment, it will be necessary to fill out a new application.
I understand that if I am employed, any misrepresentation or material omission made by me on this application may be sufficient cause for immediate termination, whenever it is discovered.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and the federal immigration law requires me to complete an I-9 form in this regard.
I understand it is the company’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. The employer does not unlawfully discriminate in employment and no question of this application is used for the purpose of limiting or excusing any applicant from consideration for employment on basis prohibited by local, state, or federal law.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice. The employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law.
This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative or employer, other than an authorized officer, has the authority to make any assurance to the contrary.
Signature of Applicant______Date______
This form is not intended to be substituted for legal advice nor does it constitute a guarantee of compliance with appropriate statures